ORCID Profile
0000-0002-8170-8339
Current Organisation
University of Tasmania
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Publisher: Elsevier BV
Date: 03-2015
Publisher: Springer International Publishing
Date: 2014
Publisher: Elsevier BV
Date: 09-2015
Publisher: Springer Berlin Heidelberg
Date: 2007
Publisher: Springer Berlin Heidelberg
Date: 2006
DOI: 10.1007/11961239_11
Publisher: Informa UK Limited
Date: 04-03-2022
DOI: 10.1080/17512433.2022.2070151
Abstract: We aimed to compare renal function changes in patients with atrial fibrillation (AF) prescribed different oral anticoagulants (OACs). We performed a retrospective analysis of Australian national primary care data. A total of 12,562 patients with AF and initiated OAC between 1 January 2013 and 31 December 2017 were included. Inverse probability of treatment weighting was used for balancing baseline characteristics and the risks of decline in estimated glomerular filtration rate (eGFR) in patients prescribed each OAC were compared. Compared with warfarin, prescribing of direct-acting oral anticoagulants (DOACs) was associated with a lower risk of renal function decline per 1000 person-years: hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.68-0.81, p < 0.001 for ≥30% decline in eGFR HR 0.28, 95% CI 0.20-0.41, p < 0.001 for eGFR decline to ≤30 mL/min/1.73 m The risk of renal function decline appeared to be lower in patients prescribed DOACs versus warfarin.
Publisher: MDPI AG
Date: 30-10-2022
DOI: 10.3390/JCM11216438
Abstract: Background: Studies investigating the association between the use of oral anticoagulants (OACs) and osteoporosis are limited. We aimed to determine the risk of osteoporosis in patients with atrial fibrillation (AF) and receiving different OACs. Methods: We performed a population-based cohort study using a nationwide primary care dataset, MedicineInsight. Patients aged between 18 and 111 years with AF and newly recorded OAC prescriptions between 1 January 2013 and 31 December 2017 were included and followed until 31 December 2018. We applied propensity score matching to control for patients’ baseline characteristic differences before calculating adjusted hazard ratios (aHRs) for a new diagnosis of osteoporosis, using Cox proportional hazard models. Results: A total of 18,454 patients (1714 prescribed dabigatran, 5871 rivaroxaban, 5248 apixaban and 5621 warfarin) were included. Of these, 39.5% were females, and the overall mean age (standard deviation [SD] was 73.2(10.3) years. Over a mean follow-up of 841 days, 1627 patients (1028 receiving direct-acting oral anticoagulants (DOACs) and 599 warfarin) had a newly recorded diagnosis of osteoporosis. The weighted incidence rates (95% confidence interval CI) per 100 person-years of treatment were 5.0 (4.7–5.2) for warfarin, 4.3 (3.8–4.8) for dabigatran, 3.6 (3.3–3.8) for rivaroxaban, and 4.4 (4.0–4.7) for apixaban. Overall, DOAC use was associated with a significantly lower risk of a new diagnosis of osteoporosis than warfarin use (aHR, 0.79, 95% confidence interval (CI) 0.74–0.85 p 0.001). Use of each in idual DOAC was associated with a significantly lower risk of osteoporosis compared with warfarin (aHRs, 0.75, 95% CI 0.69–0.82 for rivaroxaban 0.78, 95% CI 0.71–0.86 for apixaban 0.88, 95% CI 0.77–0.99 for dabigatran). Conclusion: Compared with warfarin, the use of DOACs was associated with a significantly lower risk of developing osteoporosis in patients with AF. This association remained significant when in idual DOACs were compared with warfarin.
Publisher: Hindawi Limited
Date: 02-2007
DOI: 10.1111/J.1365-2710.2007.00801.X
Abstract: The aim was to develop and evaluate a pilot version of a knowledge-based system that can identify existing and potential medication-related problems from patient information. This intelligent system could directly support pharmacists and other health professionals providing medication reviews. Rather than being based on static rules to trigger alerts, this system utilizes a multiple classification ripple-down rules approach, which allows the user to build rules incrementally and improve the accuracy of the knowledge base in identifying medication-related problems while the system is in use, with no outside assistance or training. The system contextualizes the potential drug therapy problems by taking into consideration the patient's demographics, and other medical condition and drugs. The system is capable of both being instructed in the domain of medication review through its routine use by an expert, and acting similarly to the expert when analysing genuine medication review cases. The system was handed over to an experienced clinical pharmacist (expert), with no knowledge or conclusions preloaded into the system. The expert was then able to add the case details and generate the rules required for 126 actual medication review cases. Over 250 rules were generated from the review cases, incorporating demographics, medical history, symptoms, medications and pathology results from these cases. At the completion of the cases, more than 80% of the potential medication-related problems identified by the expert were also detected by the system. The false positive rate, or number of incorrect medication-related problems identified by the system, was <10% overall and was zero for the last 15 cases analysed. The system found significantly more potential medication-related problems than the expert, with the system consistently remaining at least one finding ahead. There was a high incidence of missed potential medication-related problems by the expert, which were automatically repaired by the system. The knowledge-based system has already demonstrated that the technique employed is well suited to a domain of this nature and has furthermore demonstrated that it is capable of improving the quality of service that the medication reviewer can provide. The system will be further enhanced and tested prior to use in the field. It should help pharmacists in the provision of medication reviews, improving their clinical and time management capabilities, and enhancing their ability to contribute to the quality use of medications.
Publisher: JMIR Publications Inc.
Date: 03-08-2017
DOI: 10.2196/JMIR.6938
Publisher: Springer Science and Business Media LLC
Date: 19-11-2012
DOI: 10.1007/S11096-011-9583-1
Abstract: Drug-related problems (DRPs) are a major burden on the Australian healthcare system. Community pharmacists are in an ideal position to detect, prevent, and resolve these DRPs. Objective To develop and validate an easy-to-use documentation system for pharmacists to classify and record DRPs, and to investigate the nature and frequency of clinical interventions undertaken by Australian community pharmacists to prevent or resolve them. Setting Australian community pharmacies. The DOCUMENT classification system was developed, validated and refined during two pilot studies. The system was then incorporated into software installed in 185 Australian pharmacies to record DRPs and clinical interventions undertaken by pharmacists during a 12-week trial. The number and nature of DRPs detected within Australian community pharmacies. A total of 5,948 DRPs and clinical interventions were documented from 2,013,923 prescriptions dispensed during the trial (intervention frequency 0.3%). Interventions were commonly related to Drug selection problems (30.7%) or Educational issues (23.7%). Pharmacists made an average of 1.6 recommendations per intervention, commonly relating to A change in therapy (40.1%) and Provision of information (34.7%). Almost half of interventions (42.6%) were classified by recording pharmacists as being at a higher level of clinical significance. The DOCUMENT system provided pharmacists with a useful and easy-to-use tool for recording DRPs and clinical interventions. Results from the trial have provided a better understanding of the frequency and nature of clinical interventions performed in Australian community pharmacies, and lead to a national implementation of the system.
Publisher: MDPI AG
Date: 10-05-2023
DOI: 10.3390/JCM12103389
Abstract: Objective: Little research has evaluated trends in psychotropic prescribing and polypharmacy in primary care patients, especially those with dementia. We sought to examine this in Australia from 2011 to 2020 using the primary care dataset, MedicineInsight. Methods: Ten consecutive serial cross-sectional analyses were performed to evaluate the proportion of patients aged 65 years or more, with a recorded diagnosis of dementia, who were prescribed psychotropic medications within the first six months of each year from 2011 to 2020. This proportion was compared with propensity score-matched control patients without dementia. Results: Before matching, 24,701 patients (59.2% females) with, and 72,105 patients (59.2% females) without, a recorded diagnosis of dementia were included. In 2011, 42% (95% confidence interval [CI] 40.5–43.5%) of patients in the dementia group had at least one recorded prescription of a psychotropic medication, which declined to 34.2% (95% CI 33.3–35.1% p for trend 0.001) by 2020. However, it remained unchanged for matched controls (36% [95% CI 34.6–37.5%] in 2011 and 36.7% [95% CI 35.7–37.6%] in 2020). The greatest decline in the dementia groups by medication class was for antipsychotics (from 15.9% [95% CI 14.8–17.0%] to 8.8% [95% CI 8.2–9.4%] p for trend 0.001). During this period, the prevalence of psychotropic polypharmacy (use of two or more in idual psychotropics) also decreased from 21.7% (95% CI 20.5–22.9%) to 18.1% (95% CI 17.4–18.9%) in the dementia groups, and slightly increased from 15.2% (95% CI 14.1–16.3%) to 16.6% (95% CI 15.9–17.3%) in the matched controls. Conclusions: The decline in psychotropic prescribing, particularly antipsychotics, in Australian primary care patients with dementia is encouraging. However, psychotropic polypharmacy still occurred in almost one in five patients with dementia at the end of the study period. Programs focused on encouraging further reductions in the use of multiple psychotropic drugs in patients with dementia are recommended, particularly in rural and remote regions.
Publisher: Springer Berlin Heidelberg
Date: 2010
Publisher: Wiley
Date: 11-09-2017
DOI: 10.1002/JPPR.1253
Publisher: MDPI AG
Date: 03-05-2018
Publisher: Springer Science and Business Media LLC
Date: 27-11-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2022
Abstract: We compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large cohort of primary care patients with atrial fibrillation. We performed a retrospective study using an Australia‐wide primary care data set, MedicineInsight. Patients aged ≥18 years and newly diagnosed with atrial fibrillation between January 1, 2010, and December 31, 2017, and with no recorded history of dementia or stroke were included and followed until December 31, 2018. We applied a propensity score for 1:1 pair matching of baseline covariates and Cox regression for comparing the dementia incidence rates for OAC users and nonusers. Data were analyzed for 18 813 patients with atrial fibrillation (aged 71.9±12.6 years, 47.1% women) 11 419 had a recorded OAC prescription for at least 80% of their follow‐up time. During the mean follow‐up time of 3.7±2.0 years, 425 patients (2.3% 95% CI, 2.1%–2.5%) had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59 95% CI, 0.44–0.80 P .001) compared with nonusers. Direct‐acting oral anticoagulant users had a lower incidence of dementia than non‐OAC users (HR, 0.49 95% CI, 0.33–0.73 P .001) or warfarin users (HR, 0.46 95% CI, 0.28–0.74 P =0.002). No significant difference was seen between warfarin users and non‐OAC users (HR, 1.08 95% CI, 0.70–1.70 P =0.723). In patients with atrial fibrillation, direct‐acting oral anticoagulant use may result in a lower incidence of dementia compared with treatment with either warfarin or no anticoagulant.
Publisher: Cambridge University Press (CUP)
Date: 18-06-2020
DOI: 10.1017/S1041610220000940
Abstract: To explore the relationships between dose changes to antipsychotic and/or benzodiazepine medications and resident outcomes, including variations in neuropsychiatric symptoms, quality of life (QoL), and social withdrawal, within a multicomponent, interdisciplinary antipsychotic and benzodiazepine dose reduction program. Prospective, observational, longitudinal study. The Reducing Use of Sedatives (RedUSe) project involved 150 Australian Long-Term Care Facilities (LTCFs) incorporating auditing and benchmarking of prescribing, education, and multidisciplinary sedative reviews. A convenience s le of LTCFs ( n = 28) involved in RedUSe between January 2015 and March 2016. Permanent residents ( n = 206) of LTCFs involved in RedUSe taking an antipsychotic and/or benzodiazepine daily. Residents were excluded if they had a severe psychiatric condition where antipsychotic therapy should generally be maintained long-term (e.g., bipolar disorder, schizophrenia) or were considered end-stage palliative. Neuropsychiatric symptoms (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory (CMAI)), QoL (Assessment of Quality of Life-4D), and social withdrawal (Multidimensional Observation Scale for Elderly Subjects-withdrawal subscale) were measured at baseline and 4 months where nursing staff completed psychometric tests as proxy raters. There was no evidence that psychometric measures were worsened following dose reductions. In fact, dose reduction was associated with small, albeit non-statistically significant, improvements in behavior, particularly less physically non-aggressive behavior with both drug groups (−0.36 points per 10% reduction in antipsychotic dose, −0.17 per 10% reduction in benzodiazepine dose) and verbally agitated behavior with benzodiazepine reduction (−0.16 per 10% dose reduction), as measured with the CMAI. Furthermore, antipsychotic reduction was associated with non-statistically significant improvements in QoL and social withdrawal. Antipsychotic and benzodiazepine dose reduction in LTCFs was not associated with deterioration in neuropsychiatric symptoms, QoL, or social withdrawal. Trends toward improved agitation with antipsychotic and benzodiazepine dose reduction require further evaluation in larger, prospective, controlled studies.
Publisher: Wiley
Date: 22-01-2021
DOI: 10.1111/ECI.13489
Abstract: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA 2 DS 2 ‐VASc (CHA 2 DS 2 ‐VA) score. Overall, the CHA 2 DS 2 ‐VA score increased by a mean of 1.34 (95% confidence interval, 1.29‐1.39) points over the study period. Nearly two‐thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. Nearly one‐third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.
Publisher: JMIR Publications Inc.
Date: 21-08-2020
Abstract: umerous mobile health (mHealth) apps have been developed to support smokers attempting to quit smoking. Although these apps have been reported to be successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Owing to the high cost of smoking-related disease, it is considered worthwhile to pursue even small improvements. he aim of this study was to test a novel smartphone app that leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention. e designed and developed a smoking cessation app called “Quittr” in line with previously developed smoking cessation mHealth apps. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town,” and a premium virtual currency called “QuitCoins.” The user earns QuitCoins for using the app in a way that contributes positively toward their quit attempt, and they can redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via web-based advertising. Participants (N=175) had no direct contact with the researchers or other support staff. o significant differences in terms of engagement, retention, or smoking outcomes were found between the control and intervention groups. However, survey data indicated that the majority of the participants valued Tappy Town (10/17, 59%) and the QuitCoins rewards system (13/17, 77%). Usage data also suggested that Tappy Town was widely played and was generally appealing to users (mean total time spent in app, control group: 797 seconds vs intervention group: 3502 seconds, i P& /i .001). Analysis of the results suggests that users in the intervention group may have been negatively affected by the aspects of the chosen design, and some theories were explored to explain this unexpected outcome. lthough the novel features of the Quittr app failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws that may have adversely affected our participants before a follow-up study can be completed. ustralian and New Zealand Clinical Trials Register ACTRN12617000491369 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372661& isReview=true
Publisher: Springer Science and Business Media LLC
Date: 07-2014
Publisher: JMIR Publications Inc.
Date: 14-12-2020
DOI: 10.2196/23734
Abstract: Numerous mobile health (mHealth) apps have been developed to support smokers attempting to quit smoking. Although these apps have been reported to be successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Owing to the high cost of smoking-related disease, it is considered worthwhile to pursue even small improvements. The aim of this study was to test a novel smartphone app that leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention. We designed and developed a smoking cessation app called “Quittr” in line with previously developed smoking cessation mHealth apps. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town,” and a premium virtual currency called “QuitCoins.” The user earns QuitCoins for using the app in a way that contributes positively toward their quit attempt, and they can redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via web-based advertising. Participants (N=175) had no direct contact with the researchers or other support staff. No significant differences in terms of engagement, retention, or smoking outcomes were found between the control and intervention groups. However, survey data indicated that the majority of the participants valued Tappy Town (10/17, 59%) and the QuitCoins rewards system (13/17, 77%). Usage data also suggested that Tappy Town was widely played and was generally appealing to users (mean total time spent in app, control group: 797 seconds vs intervention group: 3502 seconds, P .001). Analysis of the results suggests that users in the intervention group may have been negatively affected by the aspects of the chosen design, and some theories were explored to explain this unexpected outcome. Although the novel features of the Quittr app failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws that may have adversely affected our participants before a follow-up study can be completed. Australian and New Zealand Clinical Trials Register ACTRN12617000491369 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372661& isReview=true
Publisher: Springer Berlin Heidelberg
Date: 2011
Publisher: Hindawi Limited
Date: 18-12-2012
DOI: 10.1111/J.1365-2710.2011.01327.X
Abstract: Drug-related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of a consistently high standard, and there is often room for improvement in the quality of their findings. Our aim was to produce computerized intelligent decision support software that can improve the consistency and quality of medication review reports, by helping to ensure that DRPs relevant to a patient are overlooked less frequently. A system that largely achieved this goal was previously published, but refinements have been made. This paper examines the results of both the earlier and newer systems. Two prototype multiple-classification ripple-down rules medication review systems were built, the second being a refinement of the first. Each of the systems was trained incrementally using a human medication review expert. The resultant knowledge bases were analysed and compared, showing factors such as accuracy, time taken to train, and potential errors avoided. The two systems performed well, achieving accuracies of approximately 80% and 90%, after being trained on only a small number of cases (126 and 244 cases, respectively). Through analysis of the available data, it was estimated that without the system intervening, the expert training the first prototype would have missed approximately 36% of potentially relevant DRPs, and the second 43%. However, the system appeared to prevent the majority of these potential expert errors by correctly identifying the DRPs for them, leaving only an estimated 8% error rate for the first expert and 4% for the second. These intelligent decision support systems have shown a clear potential to substantially improve the quality and consistency of medication reviews, which should in turn translate into improved medication usage if they were implemented into routine use.
Publisher: MDPI AG
Date: 02-01-2023
Abstract: Computer-based simulations may represent an innovative, flexible, and cost-efficient training approach that has been underutilised in pharmacy practice education. This may need to change, with increasing pressure on clinical placement availability, COVID-19 restrictions, and economic pressures to improve teaching efficiency. This systematic narrative review summarises various computer-based simulations described in the pharmacy practice education literature, identifies the currently available products, and highlights key characteristics. Five major databases were searched (Medline, CINAHL, ERIC, Education Source and Embase). Authors also manually reviewed the publication section of major pharmacy simulator websites and performed a citation analysis. We identified 49 studies describing 29 unique simulators, which met the inclusion criteria. Only eight of these simulators were found to be currently available. The characteristics of these eight simulators were examined through the lens of eight main criteria (feedback type, grading, user play mode, cost, operational requirement, community/hospital setting, scenario sharing option, and interaction elements). Although a number of systems have been developed and trialled, relatively few are available on the market, and each comes with benefits and drawbacks. Educators are encouraged to consider their own institutional, professional and curriculum needs, and determine which product best aligns with their teaching goals.
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/IMJ.15514
Abstract: Despite changes in antiarrhythmic drug (AAD) choice in patients with atrial fibrillation (AF), trends in AAD prescribing remain not investigated. We aimed to examine these changes using a nationwide Australian general practice data from 2009 to 2018. Over the 10 years, AAD prescribing in patients with AF decreased, which was mainly due to a reduction in the use of amiodarone, sotalol and digoxin. In contrast, the use of beta‐blockers and flecainide increased.
Publisher: JMIR Publications Inc.
Date: 12-2016
DOI: 10.2196/GAMES.6258
Publisher: Springer Science and Business Media LLC
Date: 04-09-2013
DOI: 10.1007/S40266-013-0116-6
Abstract: Studies have compared prescribing criteria for older people in general terms, reporting the findings without true side-by-side comparisons of the frequency and type of potential drug-related problems (DRPs). The aim of this study was to compare the frequency and type of DRPs identified by several prescribing criteria. Additionally, original pharmacist DRP findings were compared with DRPs identified using the prescribing criteria. Three prescribing criteria were automated: Beers 2012 (Beers), Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START), and Prescribing Indicators in Elderly Australians (PIEA). The criteria were applied to medication reviews of 570 ambulatory older Australian patients. DRPs identified by each set of criteria were recorded. Each DRP was assigned a descriptive term which highlighted mainly drug classes and/or diagnoses to provide a meaningful common language for comparison between recorded DRPs. Descriptive terms were used to compare the frequency and type of DRP identified by each set of criteria, as well as against original pharmacists' findings. Beers identified 399 DRPs via 21 different descriptive terms, STOPP/START identified 1,032 DRPs via 42 terms, and PIEA identified 1,492 DRPs via 33 terms. The various types of DRPs identified by all of the three prescribing criteria were represented by 53 different terms. When constrained to the same 53 different terms, pharmacists identified 862 DRPs. Each set of criteria displayed relevance through mutual agreement of known high-risk medication classes in older people. The number and scope of DRPs identified by pharmacists was best represented by STOPP/START. The application of STOPP/START may be further augmented with relevant criteria from PIEA and Beers.
Publisher: Springer Science and Business Media LLC
Date: 27-01-2018
DOI: 10.1007/S40266-018-0518-6
Abstract: Antipsychotic and benzodiazepine medications are widely used in nursing homes despite only modest efficacy and the risk of severe adverse effects. Numerous interventions have been implemented to reduce their use. However, the outcomes for the residents and staff and the economic impact on the healthcare system remain relatively understudied. The aim was to examine the clinical and economic outcomes reported within interventions to reduce antipsychotic and/or benzodiazepine use in nursing homes. Databases searched included PubMed, EMBASE, CINAHL, CENTRAL, Scopus, and ProQuest. We focussed on interventions with professional (e.g. education) and/or organisational (e.g. formation of multidisciplinary teams) components. Data were extracted from the papers that included clinical and/or economic outcomes. Two authors independently reviewed articles for eligibility and quality. Fourteen studies reported on clinical outcomes for the residents: 13 antipsychotic reduction studies and one study focussing exclusively on benzodiazepine reduction. There was substantial heterogeneity in the types of outcomes reported and the method of reporting. Change in behavioural and psychological symptoms was the most commonly reported outcome throughout the antipsychotic reduction interventions (n = 12 studies) and remained stable or improved in ten of 12 studies. Whilst improvements were seen in emotional responsiveness, measures of sleep, cognitive function, and subjective health score remained unchanged upon benzodiazepine reduction. No interventions included an economic analysis. Efforts should be made to improve the consistency in reporting of clinical outcomes within interventions to reduce antipsychotic and/or benzodiazepine medications. Additionally, the economic impact of these interventions should be considered. Nonetheless, evidence suggests that interventions that reduce antipsychotic use are unlikely to have deleterious clinical effects. The clinical and economic effects of benzodiazepine reduction remain under-reported.
Publisher: Springer Berlin Heidelberg
Date: 2010
Publisher: Springer Berlin Heidelberg
Date: 2011
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.5688/AJPE789168
Publisher: OMICS Publishing Group
Date: 05-2013
Publisher: Wiley
Date: 11-04-2011
Publisher: MDPI AG
Date: 05-11-2020
DOI: 10.3390/JCM9113568
Abstract: Background: Co-prescribing medications that can interact with direct-acting oral anticoagulants (DOACs) may decrease their safety and efficacy. The aim of this study was to examine the co-prescribing of such medications with DOACs using the Australian national general practice dataset, MedicineInsight, over a five-year period. Methods: We performed five sequential cross-sectional analyses in patients with atrial fibrillation (AF) and a recorded DOAC prescription. Patients were defined as having a drug interaction if they had a recorded prescription of an interacting medication while they had had a recorded prescription of DOAC in the previous six months. The s le size for the cross-sectional analyses ranged from 5333 in 2014 to 19,196 in 2018. Results: The proportion of patients who had potential drug interactions with a DOAC decreased from 45.9% (95% confidence interval (CI) 44.6%–47.4%) in 2014 to 39.9% (95% CI 39.2%–40.6%) in 2018, p for trend 0.001. During this period, the most frequent interacting class of medication recorded as having been prescribed with DOACs was selective serotonin/serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) antidepressants, followed by non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs) and amiodarone. Conclusions: Overall, potential drug interactions with DOACs have decreased slightly over the last five years however, the rate of possible interaction with SSRIs/SNRIs has remained relatively unchanged and warrants awareness-raising amongst prescribers.
Publisher: AMPCo
Date: 05-2018
DOI: 10.5694/MJA17.00857
Abstract: To assess the impact of a multi-strategic, interdisciplinary intervention on antipsychotic and benzodiazepine prescribing in residential aged care facilities (RACFs). Design, setting: Prospective, longitudinal intervention in Australian RACFs, April 2014 - March 2016. 150 RACFs (with 12 157 residents) comprised the main participant group two further groups were consultant pharmacists (staff education) and community pharmacies (prescribing data). Data for all RACF residents, excluding residents receiving respite or end-stage palliative care, were included. A multi-strategic program comprising psychotropic medication audit and feedback, staff education, and interdisciplinary case review at baseline and 3 months final audit at 6 months. Mean prevalence of regular antipsychotic and benzodiazepine prescribing at baseline, and at 3 and 6 months. Secondary measures: chlorpromazine and diazepam equivalent doses/day/resident proportions of residents for whom drug was ceased or the dose reduced prevalence of antidepressant and prn (as required) psychotropic prescribing (to detect any substitution practice). During the 6-month intervention, the proportion of residents prescribed antipsychotics declined by 13% (from 21.6% [95% CI, 20.4-22.9%] to 18.9% [95% CI, 17.7-20.1%]), and that of residents regularly prescribed benzodiazepines by 21% (from 22.2% [95% CI, 21.0-23.5%] to 17.6% [95% CI, 16.5-18.7] each, P < 0.001). Mean chlorpromazine equivalent dose declined from 22.9 mg/resident/day (95% CI, 19.8-26.0) to 20.2 mg/resident/day (95% CI, 17.5-22.9 P < 0.001) mean diazepam equivalent dose declined from 1.4 mg/resident/day (95% CI, 1.3-1.5) to 1.1 mg/resident/day (95% CI, 0.9-1.2 P < 0.001). For 39% of residents prescribed antipsychotics and benzodiazepines at baseline, these agents had been ceased or their doses reduced by 6 months. There was no substitution by sedating antidepressants or prn prescribing of other psychotropic agents. The RedUSe program achieved significant reductions in the proportions of RACF residents prescribed antipsychotics and benzodiazepines. Australian New Zealand Clinical Trials, ACTRN12617001257358.
Publisher: Oxford University Press (OUP)
Date: 02-02-2012
DOI: 10.1111/J.2042-7174.2012.00188.X
Abstract: Drug-related problems (DRPs) are associated with significant morbidity and mortality, with most DRPs thought to be preventable. Community pharmacists can detect and either prevent or resolve many of these DRPs. A survey-based clinical knowledge measurement tool was designed and validated to estimate a community pharmacist's clinical knowledge and ability to detect and appropriately resolve DRPs. Nine clinical cases with seven multiple-choice statements (63 statements in total) were constructed, based on scenarios that were found to occur frequently in Australian community pharmacies. The statements aimed to assess a pharmacist's ability to identify, gather relevant information about and make appropriate recommendations to resolve, a DRP. The survey was pilot tested with 18 academics at three Australian pharmacy schools, resulting in the removal of 23 statements. The survey was then administered to undergraduate pharmacy students (28 fourth-year, 41 third-year and 42 first-year students) and to 433 Australian community pharmacists who were participating in an intervention documentation trial. The pharmacists' resultant survey scores were correlated against their actual rate of documenting clinical interventions. The tool had relatively good internal consistency. Significant differences were seen between the three groups of students (P & 0.01). Community pharmacists with additional clinical qualifications had a significantly higher score than other participating pharmacists (P & 0.01). A moderate, but significant, correlation was seen between the pharmacists' survey score and their clinical intervention rate in practice during the trial (P & 0.01). The clinical knowledge measurement tool appeared to estimate a pharmacist's ability to detect and resolve DRPs within the community pharmacy environment.
Publisher: Informa UK Limited
Date: 21-07-2022
DOI: 10.1080/17512433.2022.2103540
Abstract: We aimed to compare the risk of developing osteoporosis in patients prescribed warfarin or direct-acting oral anticoagulants (DOACs) with those with no therapy. We included 37,632 patients aged between 18 and 111 years with a recorded diagnosis of AF between 1 January 2013 and 31 December 2017. Patients were followed until the diagnosis of osteoporosis, switch or discontinuation of the OAC, last clinical visit, or end of the study period, whichever occurred first. The incidences of new-onset osteoporosis were calculated using the Cox proportional hazards model. Of total, 16,995 (45.2%) had no recorded OAC prescription, and 20,637 had a recorded prescription of warfarin (6,609) or DOAC (14,028). Compared with those not prescribed an OAC, the risk of being diagnosed with new-onset osteoporosis increased in patients prescribed warfarin (HR 2.22, 95% CI 2.00-2.47, p < 0.001) and DOACs (HR 1.42, 95% CI 1.29-1.58, p < 0.001). However, the effect of DOACs was not statistically significant (HR 1.07, 95% CI 0.86-1.33, p < 0.535) after excluding patients with at least one recorded prescription of systemic corticosteroids, antiepileptics, or proton pump inhibitors. Use of warfarin or DOACs was associated with a significantly increased risk of developing osteoporosis compared with no OAC treatment.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.TIM.2021.02.008
Abstract: Phylodynamic methods have been essential to understand the interplay between the evolution and epidemiology of infectious diseases. To date, the field has centered on viruses. Bacterial pathogens are seldom analyzed under such phylodynamic frameworks, due to their complex genome evolution and, until recently, a paucity of whole-genome sequence data sets with rich associated metadata. We posit that the increasing availability of bacterial genomes and epidemiological data means that the field is now ripe to lay the foundations for applying phylodynamics to bacterial pathogens. The development of new methods that integrate more complex genomic and ecological data will help to inform public heath surveillance and control strategies for bacterial pathogens that represent serious threats to human health.
Publisher: IEEE
Date: 10-2008
DOI: 10.1109/UMC.2008.27
Publisher: AMPCo
Date: 06-2015
DOI: 10.5694/MJA15.00249
Publisher: Hindawi Limited
Date: 28-11-2011
DOI: 10.1111/J.1365-2710.2011.01322.X
Abstract: Studies of the outcomes of clinical interventions (CIs) performed by community pharmacists are limited. The economic models used in most studies of CIs have been simplistic, often failing to fully capture the counterfactual when estimating savings in health resources resulting from CIs. This paper aimed to describe the complexities involved in estimating the clinical and economic outcomes of CIs performed by community pharmacists when using expert opinion and suggest avenues for improvement. Existing models were reviewed, from which a range of key parameters required to evaluate the outcomes of CIs were identified. The considerations necessary to generate potentially more robust estimates of these parameters were discussed. CIs performed by community pharmacists may result in a multitude of effects on numerous health services. By utilizing the approaches described in this paper, researchers working in this field should be able to generate improved estimates of health resource savings and quality of life effects resulting from CIs performed by community pharmacists, when compared to previous efforts. This article offers recommendations designed to improve the robustness of evaluation when using expert opinion to evaluate CIs performed by community pharmacists.
Publisher: SAGE Publications
Date: 30-08-2201
DOI: 10.1345/APH.1Q138
Publisher: Springer Berlin Heidelberg
Date: 2009
Publisher: MDPI AG
Date: 17-05-2023
Abstract: Computer-based simulation (CBS) is an interactive pedagogical training method that has seen increased interest, especially in recent years. There is some evidence that CBS in pharmacy education is not as widely adopted compared to other healthcare disciplines. Pharmacy education literature to date has not specifically discussed the potential barriers which may cause this uptake challenge. In this systematic narrative review, we attempted to explore and discuss potential barriers that may impact the integration of CBS in pharmacy practice education and provide our suggestions to overcome them. We searched five major databases and used the AACODS checklist for grey literature assessment. We identified 42 studies and four grey literature reports, published between 1 January 2000 and 31 August 2022, which met the inclusion criteria. Then, the specific approach of Braun and Clarke for thematic analysis was followed. The majority of the included articles were from Europe, North America, and Australasia. Although none of the included articles had a specific focus on barriers to implementation, thematic analysis was used to extract and discuss several potential barriers, such as resistance to change, cost, time, usability of software, meeting accreditation standards, motivating and engaging students, faculty experience, and curriculum constraints. Ad- dressing academic, process, and cultural barriers can be considered the first step in providing guidance for future implementation research for CBS in pharmacy education. The analysis suggests that to effectively overcome any possible barriers to implementing CBS, different stakeholders must engage in careful planning, collaboration, and investment in resources and training. The review indicates that additional research is required to offer evidence-based approach and strategies to prevent overwhelming or disengaging users from either learning or teaching process. It also guides further research into exploring potential barriers in different institutional cultures and regions.
Publisher: Scitechnol Biosoft Pvt. Ltd.
Date: 2013
Start Date: 2016
End Date: 2018
Funder: Wound Management Innovation Cooperative Research Centre
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